FHL Tendonitis Pain for 1.5 Years???

by Gabe
(Boulder, CO )

Three years ago I was running and I felt like I pulled something on the outside of my right foot. It ended up healing 95% within two months. The pain was still present but it was so subtle it never bothered me at all.

Then 18 months ago I was doing some agility drills and I felt like I pulled something in my right big toe. The pain felt like it was right in the bone starting in the big toe traveling half way up that bone.

I was seen by a podiatrist and they prescribed rigid Orthotics. They seemed to give me enough relief to resume full activity. Then about 14 months ago the I started feeling additional pain along the FHL of both feet. On the right side it was the same big toe pain, pain along the FHL, and then some residual pain along the smaller toes.

On the left side it was pain along the FHL and up along my inside left ankle. This pain has lasted for about 12-14 months.

I went to see a physical therapist, massage therapist, acupuncturist with no real benefit. I had both feet x-rayed, and got an MRI on the right side...both tests revealed nothing. In addition, I had some blood work done which also came out clear. Then I got another pair of Orthotics, which again made little to no difference.

My previous activity consisted of kick boxing, running stairs, basketball, tennis, and other related sports. Now I mountain bike, swim and lift weights with only very minor pain. I would say my "constant" level of pain is always a 1-3 on the pain scale, so it is not enough for anyone to be really alarmed but it has greatly affected the way I live and I think about it daily.

Most recently, I saw a orthopedic surgeon who told me my problem was FHL tendonitis and prescribed a topical anti-inflamatory called "Voltaren Gel" and prescribed physical therapy.

In the PT sessions we focusing on walking with my feet straightforward and lightly pushing off with my big toe (this has helped to a small degree).

In addition, the PT is manually working on removing inflamation from both feet and using dry needling techniques to loosen up my lower legs.

Lastly, the PT has prescribed Yoga to generally loosen up my body and my right hip which is particularly tight. Again all of this has helped but in a very minor way.

Any help or suggestions that substantially work would be regarded as a gift from above!!!

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Joshua Answers:

Hi Gabe.

Dry needling, ouch!

So yes, walk like the PT is showing you. That's good all the way around. The last many months I've been experimenting with barefoot walking and the lower leg/feet, and of course it connects to hips etc.

When you walk with pressure on the big toe sides of the feet, that activates the arches. When your hips are tight and outwardly rotate you leg, that causes, or is the result of, weight onto the outside/little toe side of the foot. In my case, that explains why my arches have been slowly collapsing this past many years.

Yoga is great. Anything that lengthens is good. And depending on what you're doing in class, most yoga is great for that, especially if you keep at it, or even do just a little bit regularly.

Orthotics...ehh. I'm not a fan. Your foot is supposed to be the arch. If it's not doing it's job, the body needs to be retrained, as opposed to being subjected to an artifical arch that just has your body continue to get weaker and weaker at doing that task. Just my opinion of course.

That you've hurt for a year and a half isn't necessarily surprising. There's impact injury, and then there's the long, slow changes in how the body moves/holds itself, which often ends in what seems to be an impact injury but is really just the body giving up because it can't take the force/load anymore.

Thus you have to find what's not working, and make it work. Chances are, where you hurt isn't the source of the problem and is just a symptom.

Great, what are you supposed to do with that bit of knowledge?

Find the spot(s).

In a simple statement, you just go looking for what hurts, and for what is tight, in the foot and lower leg, and go after it.

Comments for FHL Tendonitis Pain for 1.5 Years???

I have had tenosynovitis of the FHL tendon for 3 years non-stop now in my left ankle. There was no specific event that triggered it.

The pain is deep in my ankle, on the inside and sometimes at the front of the joint. It also sometimes (though not often) extends to my big toe and the inside of my calf muscle often aches.

It is at its worst when I am standing still, walking seems to distract me from the pain and it often throbs when I sit/lie down. Overall, I'd stay standing is worst.

I have had 2 MRI's, seen an orthopedic surgeon, had a ultrasound guided cortisone injection, regular physio with no beneficial results.

I then decided to see a sports physician who said the issue was with my arches and how I walk. He referred me to a podiatrist - the podiatrist gave me some off-the-shelf insoles with arch support to trial. He suggested I try these before going custom made so that I do not waste money - if I see no benefit from the off-the-shelf insoles then no point in going for a custom made pair.

The insoles have helped mitigate the pain somewhat but there has been very little overall improvement. Since wearing the insoles (only for the last couple of months) I have for the first time noticed slight aching pains in the same place on my right ankle which is worrying!

Please help me!

Many thanks

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Joshua Comments:

Hi Jonny.

'A problem with the arches...' What does that even mean?

From your podiatrist etc it means 'there's something wrong with your arch, I can't fix it, probably don't even know what the actual problem is, don't know what caused it if I do, so let's put an insert in and see what happens'.

What it should mean is that the musculature that supports etc the arches isn't functioning correctly.

The hope is that inserts somehow make things better. Sounds like they have made your day to day experience better, but they totally ignore the CAUSES of the original complaint.

Which will predictably get worse over time....that's just how it works.

The focus should be on your lower legs even though it's your feet/ankle that hurt. Structures in the lower leg aren't functioning correctly.

Those structures connect to your feet/arches.

If you want your feet/ankle to feel better you need to get your lower leg(s) working better.

I suggest the Reversing Achilles Tendonitis program. You don't have achilles tendonitis per se, but you have all the factors involved (muscle and connective tissue tightness, inflammation, nutritional insufficiency, etc).

We could call the program 'Reversing FHL Tendonitis', replace every instance of 'achilles' with 'FHL', and it would be the same.